Leg cramps at night in women, men and children

Leg cramps at night can appear in people of different ages, different constitutions and with different complaints. Most often, seizures are of a short-term nature, and they disappear after the restoration of normal blood circulation. But sometimes they require systematic treatment and are difficult.

Muscle spasms are sudden, involuntary, painful contractions of skeletal muscles. [1]They are characterized by electrically repetitive shots of motor unit action potentials at speeds of up to 150 per second, [2]more than four times the normal speed at maximum voluntary contraction.[3]

The muscle spasm was described as “a sudden, involuntary and painful muscle contraction that gradually decreases. During seizures, the affected muscles harden and the joints may be forced into unusual positions. In some people, seizures can be triggered by certain movements and / or stopped by stretching the muscles. ”This definition was based on descriptions in the literature [4]and on clinical experience describing seizures in patients.

Causes leg cramps at night

There are quite a few reasons why leg cramps may occur at night. This is, first of all, a violation of metabolic processes, both at the cellular and tissue levels. They can occur due to a deficiency of the main mineral components, vitamin. Also, violations can occur in connection with trauma, prolonged squeezing and compression of the muscle, in which not only metabolic processes are disturbed in it, but also blood circulation and innervation. There is also a sharp increase in carbon dioxide levels and a decrease in oxygen levels in the blood. The reason may be depletion of the body, insufficient level of physical and physical activity.[5], [6]

It should be borne in mind that the causes of seizures are always individual. Therefore, a serious diagnosis is needed. No specialist will be able to immediately name the cause of the seizure without conducting an appropriate comprehensive examination. Convulsions can also occur in connection with pathologies such as pinched nerve, inflammation. It may be the result of pinched or displaced nerve, the development of arthrosis, osteochondrosis.

The cause may be disorders of the nervous and endocrine systems, pathologies that develop against the background of nervous overstrain, stress, chronic fatigue. Often this is observed against the background of pregnancy, during the lactation period, as well as in the menopause, in postmenopause. Convulsions can be both a consequence of a lack of vitamin in the body, and a symptom of epilepsy or traumatic brain injury. Cancer and cancer treatments can cause problems that lead to patients having leg cramps and other types of muscle spasms.

Why and why are there leg cramps at night?

Before starting treatment for leg cramps, you need to know exactly why they occur, why they get worse at night. For this, it is advisable to consult a doctor and undergo a diagnosis. Only knowing the exact cause of the development of pathology, you can choose the appropriate treatment that will be effective.

• What is missing for leg cramps at night?

Usually, the onset of leg cramps, especially when they get worse at night, is due to the fact that the body lacks certain substances. What is missing can be determined during the diagnostic process. The doctor must conduct a thorough analysis, interview the patient, collect a detailed medical history. It is important to know which diet predominates in a person, what exactly may be lacking in it. Most often, seizures are associated with a lack of protein components, individual amino acids (mostly irreplaceable). Often there is not enough vitamin. Muscles are especially sensitive to vitamins of group B, D. Also, with a lack of certain proteins, peptides, a similar condition may occur.

• Leg cramps at night with varicose veins

With varicose veins, a sharp violation of blood circulation occurs, stagnation occurs. Accordingly, the blood supply to the internal organs and muscles is disrupted. The condition of muscle tissue, its contractile activity, and metabolism are disrupted. Depletion and disturbance of innervation in muscle tissue occurs. The metabolism is gradually disrupted. The excretion of toxic substances, end metabolites, carbon dioxide from the body is slowed down. The supply of oxygen and nutrients to muscle tissue is significantly slowed down. For this reason, with varicose veins, the risk of developing leg cramps increases significantly. They mostly get worse at night. But the reason for this phenomenon is still not fully understood.

• Leg cramps at night with diabetes

In people with diabetes, the occurrence of seizures is associated with the presence of neuropathy, with increased excitability of the peripheral nerve. Type I diabetes has a lower incidence of seizures (about 60%) compared to type II diabetes (about 80%). In type II diabetes, nephropathy is another factor in the onset of seizures. Another likely cause of seizures is associated with changes in peripheral vascularization, causing episodes of ischemia and seizures.

With diabetes, the risk of developing leg cramps increases dramatically, especially at night. This is due to the fact that diabetes is associated with metabolic disorders in various tissues, especially in muscle tissue. Mild intoxication develops, a lack of nutrients. The main disorder affects the condition of the blood, which also affects the muscular system. In particular, an increased level of glucose in the blood negatively affects intracellular processes, contractility of muscle tissue, disrupts metabolic processes, and leads to intoxication.

• Seizure-fasciculation syndrome

Spasm fasciculation syndrome (CFS) is a peripheral syndrome associated with increased excitability of the peripheral nervous system. This situation leads to the presence of unwanted muscle spasms and / or fasciculations. Some subjects may develop other symptoms, such as numbness and burning sensation typical of neuropathy. These patients are often found to have antibodies to the detriment of potassium channels, with a predominantly male gender. We do not have an adequate explanation or treatment for this condition.

• End stage renal failure

People with chronic kidney failure undergoing dialysis often suffer from muscle spasms, up to 50%, especially involving the lower extremities. Seizures can occur during dialysis or at home. Cramps in this type of patient are associated with depression, poor quality of life, and sleep disturbances. The etiology of seizures in patients on hemodialysis is not clear.

One of the possible reasons is the presence of polyneuropathy, typical in these situations, with morphological and functional changes in peripheral nerve fibers. A kidney transplant significantly reduces the presence of seizures.

• Amyotrophic lateral sclerosis

About 95% of patients with amyotrophic lateral sclerosis (ALS) report seizures. The frequency and intensity of seizures are not related to the severity of the disease. The causes of these seizures are little known, but they are probably associated with increased excitability of neurons. The drugs that reduce seizures in these patients are mexiletine and quinine sulfate, the latter with serious contraindications.

• Cirrhosis of the liver

Muscle cramps in this patient population are common and common (88%). In an electromyogram, the activation of the involuntary potential action of motor units was quite high - more than 150 Hz. The behavior of the peripheral nervous system is not associated with nervous degeneration. The reason for the presence of seizures remains unclear. The presence of seizures varies depending on the area of the muscles: cervical spine (9%), thigh (43%), lower leg (70%), toe (50%), abdominal muscles (12%) and fingers (74%). Other areas of the body may be affected. No direct link has been established between age or specific causes that lead to cirrhosis (alcohol, infection, etc.). It is known that there is no single cause or specific treatment to avoid seizures in patients with cirrhosis.

• Anti-myelin-associated glycoprotein antibody (anti-MAG) neuropathy

About 60% of patients have a seizure phenomenon, especially affecting the lower limbs and upper limbs (only 20%). Most of the events take place at night or during exercise. There is no valid explanation as to how this pathology is due to the presence of seizures, and there is no therapeutic strategy for limiting this phenomenon.

• Fibromyalgia

According to the National Rheumatic Diseases Databank, seizures are one of ten comorbidities affecting patients. One of the most probable causes is the hyperexcitation of the peripheral nervous system. According to recent studies, the presence of seizures and peripheral neurological changes is directly related to the severity of the disease and is inversely related to the quality of life.

Risk factors

The risk group includes people with a history of blood diseases, metabolic disorders, decreased immunity, trauma, congenital and acquired diseases of the musculoskeletal system. In particular, conditions such as cerebral palsy, diabetes mellitus, varicose veins, Dejerine's syndrome, paralysis, hyperkinesis, peripheral vascular disease, epilepsy, electrolyte imbalance, peripheral neuropathy, angina pectoris, and arthritis should be considered as risk factors. Also, the risk increases significantly in case of innervation disorders, compression of blood vessels and nerves. A multicenter American study found that patients with COPD suffer from 46% of muscle spasms, which appears to be the main cause of pain in this patient population. Another multicenter American study found that 74% of seizures occur in athletes and in high ambient temperatures.

Also at risk are people with various disorders of nervous and hormonal regulation. The risk of seizures increases significantly if a person lives and works in dampness, in conditions of high humidity. The risk group also includes people suffering from various diseases: these are lumbodynia, radiculitis, and pinched nerves, arthritis, osteoarthritis, osteochondrosis, and inflammatory processes. People with physical inactivity who lead a sedentary, sedentary lifestyle, long-acting beta-agonists, statins and diuretics are also at risk.[7]

The elderly are at risk due to the natural aging processes of the body. [8] This group also includes pregnant women who are nursing mothers, since their muscles are more stressed.

Pathogenesis

The pathogenesis is based on molecular and biochemical processes that affect the cell, then the entire muscle tissue. First of all, biochemical reactions in the cells and tissues of the muscular system are disrupted, the mechanisms of exchange of calcium, potassium, phosphorus are disrupted. The main links of the Krebs cycle, which ensures the normal functioning of the cell, also become pathological, and the mechanisms of metabolism of carbohydrates and energy are disrupted. The contractile activity of muscles decreases, hypoxia develops, in which the body does not have enough oxygen, oxygen starvation develops. Hypercapnia also develops, in which an excessive amount of carbon dioxide accumulates in the body, since the mechanisms for its excretion are disturbed.[9]

It should be noted that seizures often occur in connection with a violation of the permeability of the cell membranes of myocytes, in which a sufficient amount of calcium ions cannot penetrate into the cell. An excessive amount of potassium accumulates in the cell, as a result of which the sodium-potassium pump (one of the mechanisms of regulation of the internal environment of the cell) is disrupted. In this regard, the main pathological processes develop, as a result of which spontaneous electrical activity of the cell arises, and the intracellular potential increases. This leads to violations at the level of the entire muscle tissue, after which leg cramps occur (mainly at night).[10]

After that, all skeletal muscles are involved in the pathological process, they can periodically undergo spontaneous electrical activity, as a result of which the muscle contracts spontaneously, and also cannot fully relax.

Also, pathogenesis can be associated with disturbances in nerve conduction, sensitivity and susceptibility of nerve receptors, pathways. Any part of the nervous system can be subject to pathological changes, ranging from receptors that perceive changes in the muscle, and ending with the corresponding parts of the brain, which perceive and process information accordingly.

Epidemiology

According to statistics, every person, at least once in his life, has a seizure under any circumstances. Even the strongest people, keeping themselves in good shape, are subject to periodic seizures. So, for many, convulsions occur when swimming, diving in cold water bodies, during winter swimming. Every second person had a spontaneous convulsion at night at least once. As a rule, they pass quickly enough, it is enough to change the position of the body, walk, put your foot on a flat surface, or just rub the area affected by the convulsion well.[11]

But it often happens that seizures occur due to the fact that systematic violations occur in the body, as a result of which there is a prolonged compression of the muscle. Gradually, a steady state develops, accompanied by convulsive syndrome. As statistics show, approximately 50% of seizures occur due to a lack of certain substances, including vitamins, minerals. Another 24% of seizures occurs spontaneously, under the influence of any factors of the external and internal environment, under the influence of trauma, damage. It is also worth noting that all other seizures occur mainly against the background of any diseases, metabolic processes, with insufficient mobility. We can say that seizures often occur due to the fact that a person leads a sedentary lifestyle (about 65% of pathology), the remaining 35% fall under congenital or acquired pathologies, in connection with which seizures occur.[12], [13], [14], [15]

Symptoms

Severe compression of the limb is considered as the main symptoms of seizures, in which a person complains that he cannot bend or straighten the limb. Muscles contract, tighten, contracture, pain occurs. As a rule, if you work out a muscle, rub it, the symptoms gradually subside due to the fact that blood circulation improves. Also, the pain can be throbbing, stabbing, there is a feeling of coldness in the limb.

Violation of the normal state of the limb is considered as the first signs of convulsions. In this case, there is discomfort, a burning sensation, sometimes pain, and strong pressure in the muscle, a feeling of its excessive compression, squeezing. When the first signs appear, you need to see a doctor as soon as possible to diagnose and prescribe the correct treatment.

There are several types of seizures, depending on the cause. So, congenital convulsions are isolated, which arise in connection with the development of congenital diseases, are genetically determined and poorly treatable, or cannot be treated at all. They are progressing intensively. Often arise against the background of pathologies such as epilepsy, convulsive syndrome, various paralysis, dystrophies, neuropsychic pathologies.

The second type of seizures is acquired. They arise in connection with the peculiarities of human life. For example, they develop against the background of a lack of vitamins, certain substances in food, are a frequent complication of any disease, are a consequence of metabolic disorders. Usually, in this case, an etiological treatment is required, which is aimed at eliminating the cause of the seizures, after which the state of the muscular system is automatically restored.

• Cramps in the muscles of the calves at night

At night, the body relaxes, the load is removed from the legs and internal organs. It improves innervation and blood circulation. A large amount of oxygen is suddenly supplied to the muscles, as a result of which a spasm develops from oxidative stress. In this case, a violation of metabolic processes occurs, an acceleration of metabolism.

To eliminate seizures, remedial gymnastics are widely used. They act as the main treatment. The means and techniques of active and passive gymnastics, proper breathing, stretching exercises and coordination of movements are especially effective. You can use various sets of breathing exercises. The practice should consist of a sequence of static, dynamic and breathing exercises. Better to end with relaxation training, light meditation.

You need to understand that without physiotherapy exercises, no treatment will be effective. It is used to relieve pain, eliminate symptoms, improve muscle trophism, reduce or completely eliminate muscle tone disorders, and prevent bone and spine deformation. The selection of physical therapy means is determined primarily by the reasons, as well as by those main goals and objectives that must be achieved. It is important to combine classes with massage, manual therapy, reflex gymnastic exercises.[16]

• Cramp in the left, right leg at night

Leg cramps can occur for various reasons. They occur with the same frequency both in the left and in the right leg, and intensify mainly at night. This is due to the peculiarities of metabolism, the intensity of metabolic processes, blood circulation, innervation. The lower the intensity of these processes, the lower the oxygen content, the higher the carbon dioxide level. To relieve seizures, compresses are applied, lotions are made.

• Constant severe leg cramps at night

If the cramp occurs periodically, this is not yet a cause for concern. It can occur for various reasons, including in connection with impaired blood flow, clamping of a limb, prolonged stay in the same position. But, if cramps in the legs become severe, and constantly bother you, mainly at night, you need to see a doctor and undergo a comprehensive diagnosis. And determine the cause of the pathology. Then the optimal treatment will be selected, which will help to get rid of the problem quickly and in a short time.

Instrumental diagnostics is one of the main methods that allows you to make a correct diagnosis. Methods of CT, MRI, fMRI, electroencephalography are used. The essence of the methods is to study the electrical activity of various structures of the brain. Myoelectroencephalography measures the electrical activity of the muscles. In the course of the study, potentials are registered. The result of such studies is the compilation of mapping of brain activity, as well as mapping of muscles.

Treatment is etiological, that is, it depends on what pathology is identified. For example, cramps often occur as a result of a lack of magnesium in the body, so it is necessary to prescribe magnesium preparations, and the situation will improve significantly. If the normal functioning of the brain is disturbed, the essence of therapy is to normalize its functional state. With the pathology of the muscles itself and circulatory disorders, it is necessary to resort to physiotherapy exercises and restorative therapy. Shown are manual therapy, massage. Basically, therapy is quite long.

Mainly drug therapy is used. Also, preference is given to complex therapy (the complex treatment includes appropriate physiotherapeutic methods, alternative means, homeopathy). The most effective etiological treatment, that is, it should be aimed at identifying and further eliminating the cause of the pathology. Symptomatic therapy means are adjuvants. They also use tools for manual therapy, massage, exercise therapy, breathing exercises, exercise therapy, hatha yoga, qigong, swimming, hydrotherapy.

If necessary, provide emergency assistance, resort to symptomatic therapy, relieve the seizure itself and temporarily relieve the condition. Includes means of manual exposure, rubbing, kneading the affected area, which will provide access to blood and oxygen to the site of the convulsion. Accordingly, it will relieve pain and relax the muscle. If this does not help, you need to take an anticonvulsant or antispasmodic.[17]

• Pain and cramps in the legs at night

In the event of pain and cramps in the legs with a predominant increase in them at night, there is a need for diagnosis, determination of the cause of the pathology and further treatment. Seizures accompanied by pain usually indicate that nerve fibers are involved in the pathological process, and that severe damage to muscle fibers, cells and tissues occurs. They require compulsory treatment.

The therapy is based on special anticonvulsants, anticonvulsants, muscle relaxants, and painkillers.

The simplest remedy used for seizures is no-shpa. Take a tablet 2-3 times a day (regardless of the presence or absence of seizures). The course of treatment is 10-14 days.

At the moment when the cramp arose, this place should be well massaged, using first light strokes, then deeper kneading and rubbing. Vibrational movements, as well as active-passive movements, muscle stretching relieve convulsions well.

For more severe and prolonged convulsions, carbazepam (3-5 mg / kg body weight) is used. It is recommended to take a course of treatment, on average 14-28 days.

The most powerful agent that helps to cope with seizures is trometamol (60 mg / day, 2 times a day). The drug causes numerous side effects.

For cramps in the legs, various ointments are used. For example, troxevasin-gel, traumalgon, dolobene, chondroitin, chondroxide, larkspur, saber, bee venom.

When seizures appear, it is necessary to take vitamins, since most seizures are associated with hypovitaminosis or vitamin deficiency. Convulsions., Are often associated with a lack of vitamins A, E, PP.

Physiotherapeutic methods are also used. Of all the methods of physiotherapeutic treatment, various thermal procedures, electrical procedures, including electrophoresis, have proven themselves in the best way, which allows you to deliver active substances directly to the inflammation focus, and also increases the electrical activity of muscles and nerve impulses. It is recommended to alternate physiotherapy with massage, manual therapy sessions.

Various procedures with water contribute to relaxing muscles and relieving excessive tension, spasms: swimming in the pool, water aerobics, Charcot's douche, hydromassage, jacuzzi, hirudotherapy, dousing, rubbing, compresses, hardening.

• Cramps in legs and arms at night

The appearance of cramps in the legs and arms at night indicates that a rather large area of muscle and nervous tissue is involved in the pathological process. In addition, this may be a sign of the development of a persistent convulsive syndrome, which continues to progress.

In the process of diagnosing, it is important to separate the signs of one disease from another. This is primarily due to the fact that seizures are a sign of many pathologies and diseases.

For diagnostics, you need to see a doctor. He will make a diagnosis and only on the basis of it can a treatment be selected. Various studies are used to make a diagnosis. The main methods are standard clinical tests such as stool, urine and blood tests. They can be very informative.

Depending on what results were obtained, a further research plan is being developed. If necessary, functional tests are used, which can be very informative and allow for a fairly fine differentiation of various diseases and syndromes. Since a lack of vitamins or minerals is often the cause of seizures, a vitamin test may be required. Sometimes genetic methods (genetic screening) are used if a genetic abnormality or congenital pathology is suspected.

• Cramps in toes at night

Often you have to deal with such a phenomenon as leg cramps, which appear and intensify at night. Most often, the reason is that a person either does not move enough, as a result of which metabolic processes in the lower parts of the body, in the limbs, and especially in the fingers, are disrupted, since this is the distal part. In addition, a similar picture is often observed against the background of diseases such as varicose veins, convulsions, epilepsy, hypertension, vascular sclerosis, which only aggravate the pathology.

An equally common reason is, on the contrary, excessive load on the legs, the musculoskeletal system. This is due to the fact that excessive oxygen demand can develop as a result of increased fatigue. With its lack in the body, a spasm develops. Also, against the background of edema, cramps in the toes may develop, with a predominant increase in the night.[18]

Leg cramps at night in a child

For various reasons, a child may experience leg cramps, especially pronounced at night. So, this may be due to a number of reasons, in particular, the accelerated growth and development of the body, in which the processes of skeletal growth are accelerated, while the muscular system does not keep pace with the growth of bones. Accordingly, an imbalance occurs, a violation of metabolic processes, which are associated with the occurrence of seizures. It is also worth noting that often the cause of the development of seizures is nervous stress, overexertion, psychosis, neurosis. Often, seizures are observed against the background of experiences, stress, excessive emotions, both positive and negative. Usually, seizures occur during the period when the child is in the stage of adaptation: when changing the team, when moving from kindergarten to school, when entering a kindergarten or school. With increased mental and physical exertion, convulsions can occur. Often, seizures develop in first-graders, as well as before important events and activities.

Leg cramps at night in a teenager

In adolescence, you often have to deal with such a problem as leg cramps. In a teenager, they develop most often at night. Most often, such a pathology is associated with a transitional period, when there is a restructuring and adaptation of the body. During this period, numerous mental and physical neoplasms arise, the hormonal background changes, metabolic processes are disrupted.

Teenagers can experience numerous experiences, stresses, and therefore seizures can also occur. Strenuous mental and physical activity, fatigue, lack of sleep, early getting up, can lead to the fact that the teenager also develops leg cramps. At night, they intensify due to the fact that the body relaxes, and from the previously clamped tissues, muscle fibers, metabolic by-products begin to be intensively excreted, the need for oxygen and nutrients increases sharply.

It is also worth noting that in adolescents, convulsions can be associated with both inadequate level of physical activity, movement, and excessive stress, muscle overtraining. Sometimes an incorrectly selected training regimen, unhealthy diet, a lack of certain substances in the diet, can lead to the development of seizures.

Leg cramps at night in the elderly

Due to numerous age-related changes, adaptation processes, menopause, changes in hormonal levels, the elderly often develop leg cramps, which intensify at night. Dystrophic and degenerative processes develop in the nervous and muscular system, the muscles undergo aging. Blood circulation, innervation, nerve impulse conduction are impaired.

It is also worth noting that the aging process is often accompanied by a decrease in the intensity of metabolic processes, as a result of which muscles, nerve fibers lack nutrients and oxygen. At the same time, the outflow of metabolites and toxins is also disturbed, which entails an increased content of carbon dioxide, by-products of metabolism in the body.

Leg cramps at night during pregnancy

Muscle cramps in women during pregnancy are very common, about 50%; especially in the last 3 months and at night.

The exact cause of this disorder is not fully understood. These can include changes in neuromuscular function, excessive weight gain, compression of peripheral nerves, insufficient blood flow to the muscles, and increased muscle function in the lower extremities.

During pregnancy, first of all, cramps and swelling in the legs develop, which mainly appear at night and in the morning. This is due to the high load on the lower limbs, as well as impaired circulation. In addition, there is an accumulation of metabolic by-products, carbon dioxide, cells and tissues do not receive enough oxygen and nutrients. This leads to spasm, pain, convulsions. Toxicosis enhances these phenomena. Also, the symptoms increase under the influence of the increasing fetal weight, an increase in the woman's body weight, due to hormonal changes, immune and adaptive processes.

The prevalence of seizures in pregnant women in China affects the calf area, with a percentage of 32.9%. During the first trimester, the response rate is 11.6%, the second trimester, 28.2%, and the last trimester, 50.2%. Pregnant Indian women are most likely to experience cramps in the third trimester, especially in the lower leg (64.6%).[19], [20]

There is currently no adequate treatment to reduce the incidence of seizures.

Diagnostics leg cramps at night

In the process of diagnostics, the most important role belongs to differential diagnosis, the essence of which is to separate the signs of one disease from another. This is primarily due to the fact that seizures are a sign of many pathologies and diseases. For example, seizures are equally likely to be a consequence of a lack of vitamin in the body, and a symptom of epilepsy or traumatic brain injury.

For diagnostics, you need to see a doctor (diagnostician, therapist, surgeon, traumatologist, orthopedist - there is a fairly large selection of specialists). They must make a diagnosis and only on its basis select a treatment. During the diagnosis, various diagnostic methods are used. It all starts with a classic inspection. If necessary, functional tests are used, which can be very informative and allow for a fairly fine differentiation of various diseases and syndromes. Also, laboratory and instrumental research is almost always used.

Analyzes

Various studies are used to make a diagnosis, including laboratory ones. The main methods are standard clinical tests such as stool, urine and blood tests. They can be very informative if only because they show an approximate direction for further research. For example, tests can show whether an inflammatory, infectious, allergic, or autoimmune process is developing in the blood. Depending on what results were obtained, a further research plan is being developed. For example, if a viral infection is suspected, various virological tests are prescribed. If a bacterial infection is suspected, bacteriological examination, microbiological screening, cultures and scrapings may be prescribed.

If rheumatic and autoimmune processes in the body are suspected, rheumatic tests, analysis for C-reactive protein, biochemical studies, and immunogram are prescribed. If allergic diseases are suspected, allergic tests, an immunogram, an analysis for immunoglobulin E are prescribed. It may also require an analysis for the vitamin content in the body if vitamin deficiency or hypovitaminosis is suspected, and other similar studies. Sometimes genetic methods (genetic screening) are used if a genetic abnormality or congenital pathology is suspected.

Instrumental diagnostics

It is one of the main methods that allows you to make a correct diagnosis. In diagnosis, various methods are used, depending on which pathology is suspected. The essence lies in the use of special tools for diagnosis, registration of physiological and functional changes in the body.

For example, to determine the causes of seizures, various methods of studying the functional activity of muscles and the brain are often used. So, methods of MRI, fMRI, electroencephalography are used. The essence of the methods is to study the electrical activity of various structures of the brain.

Myelectroencephalography helps to examine the electrical activity of muscles and, based on the data obtained, suggest the likelihood of developing a seizure syndrome. The essence of the application of various methods for studying the brain is that with the help of special equipment, impulses and potentials are recorded during the activation of various structures of the brain. Potentials are registered. The result of such studies is the compilation of a mapping of brain activity, which is based on averaged and statistically processed data. You can also plot the changes taking place in various structures of the brain. [21]

The method of functional magnetic resonance imaging can be quite informative, the essence of which consists in recording individual potentials and studying the functional specialization of individual structures of the brain, identifying possible deviations from the norm, which can cause the development of seizures. The fMRI method is based on the response of electrodes to a local change in blood flow in the brain. So, any changes in the body, including convulsions, spasms, cause a local change in blood flow. As a result, the hemoglobin content in the blood changes. It is these dynamic changes that the system registers. The result is displayed in the form of a statistically processed graph that reflects the characteristics of the hemodynamic response to stimulation. Based on the results, you can make a statistical map of brain activity. [22]

Differential diagnosis

A spasm is a painful contraction of short duration and can be distinguished from other muscle contractions. Dystonia is a painless contraction of central origin, and myotonia is a prolonged painless contraction, as in the case of myotonic dystrophy and Thomsen's dystrophy. Tetani can be painful, but rarely affects only one muscle area, such as Kamurati-Engelmann disease, anorexia nervosa (Russell's sign), or in cases of hypocalcemia. Myalgias are muscle pains that are not necessarily contracted for several reasons, such as vitamin D deficiency, drug abuse, or spastic hypertension following central nervous system damage. Muscular pain in the lower extremities when walking or intermittent claudication is a symptom of peripheral vascular stenosis. In these cases, a cramp may occur if the patient continues to walk. Restless leg syndrome is involuntary contractions of the lower extremities that do not cause spasms, but only soreness and muscle fatigue when contractile activity ceases. Such contractions can also be symptoms of parkinsonism.

A cramp is not a trigger point. The latter can be sharp or covert and described in various ways. According to recent studies, the mentioned pain of a small area and hypersensitive spot can be defined as a tight streak. Another important factor is that the trigger point does not necessarily create pain; it can cause localized or extended sensory disturbances, tingling, burning, and dull pain. 

For further differential diagnosis between a seizure of a physiological state and a seizure in the presence of pathology, the simplest examination is electromyography. More detailed tests, such as magnetic resonance imaging or computed tomography, can reveal any neurological lesions.

Another observational assessment to understand whether a seizure is benign is whether the localized musculature has developed a morphological abnormality: hypertrophy or atrophy. Weakness is another sign that can lead to the assumption that the seizure is a symptom rather than an isolated occurrence. If there is a wind phenomenon, further muscle contraction is caused by very weak afferents.

If in doubt, blood tests can be done to detect myoglobinuria and hyperkalemia (more than 2-3 times normal). The literature emphasizes that muscle biopsy studies can also be performed to detect cellular changes such as atrophy or phenotypic changes.

For night leg cramps (NFA) disorder, there are seven differential symptoms that can be compared to other sleep-related diseases: severe pain, a maximum period of 10 minutes for the presence of cramping, areas located like the calf or leg, and less frequently up to the thigh (quadriceps muscle and sciatica muscle) soreness that persists after the cramps disappear, the sleep cycle changes and subsequent stress.

The essence of differential diagnosis is the need to differentiate the signs of one disease from the signs of another disease, which has similar manifestations. It is also important to identify the cause of the pathology. Further treatment depends on the correct definition of the cause and pathogenesis. For example, if the reason is a lack of certain substances in the body, you must add these substances. In the event that the cause is any pathology, it is necessary to take measures in order to get rid of it. In this case, special therapy may be required. At this stage, laboratory and instrumental research methods are widely used.

Complications and consequences

Often, seizures are accompanied by adverse consequences and complications, which are primarily associated with circulatory disorders, innervation, and metabolic processes. Locomotor activity, nutrition and blood supply to muscle tissue and nerves are impaired. Pinching of nerves is quite dangerous, which can be accompanied by pain, progression of spasm and convulsions with the subsequent development of the inflammatory process, involvement of other organs and tissues in the pathological process.

Radiating pain and progressive convulsions are considered as the main complications. Convulsions can turn into a chronic form, which will be accompanied by periodic attacks, exacerbations. Temporary or permanent disability develops (depending on the severity of the condition), disability, and unsuitability for military service.

At first, leg cramps occur at night, over time, they can appear during the day. This is due to the destruction of muscle fibers, the accumulation of metabolic by-products. It is also observed by a pinched nerve with severe convulsions, which subsequently develops into neuralgia, followed by the development of inflammation, and the chronization of the process. Ultimately, paralysis may develop, which leads to disability.

Prevention

Prevention is based on maintaining a high level of physical activity, regular exercise aimed at normalizing blood circulation, respiratory processes. If necessary, you need to take a course of vitamin on drink, inject additional preparations containing magnesium into the body (since convulsions often occur due to a lack of magnesium). [23]

It is also necessary to eat well, maintain water balance, work and rest, eliminate stress and nervous tension. In addition, you need to undergo regular medical examinations for persons who are prone to seizures due to the presence of various structural or functional disorders of the brain and spinal cord, muscles, peripheral nervous system, genetic abnormalities and congenital abnormalities. If treatment or preventive measures are required, they need to be taken regularly. An important preventive measure is the periodic passage of a course of physiotherapy exercises, manual therapy, massage.

Forecast

If the necessary therapeutic and preventive measures are taken in a timely manner, the prognosis can be favorable. Usually,  cramps in the legs at night  can be easily treated with medication. If you follow the doctor's recommendations, you can minimize or completely eliminate the adverse effects. In the absence of adequate treatment, seizures can intensify and progress, up to the development of paralysis and disability. In healthy people, the prognosis for the onset of seizures is always favorable.